The Episcopal Diocese of Oklahoma
The Episcopal Diocese of Oklahoma
Pay Check Direct Deposit Authorization Agreement I hereby authorize The Episcopal Diocese of Oklahoma to initiate automatic deposits to my account at the financial institution named below. I also authorize The Episcopal Diocese of Oklahoma to make withdrawals from this account in the event that a credit entry is made in error. Further, I agree not to hold The Episcopal Diocese of Oklahoma responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. This agreement will remain in effect until The Episcopal Diocese of Oklahoma receives a written notice of cancellation our business office, or until I submit a new direct deposit form to the Accounting Department.
Account Information #1
Name of Financial Institution:
%________________
Routing Number:
$_________________
Account Number:
☐ Checking | ☐ Savings
Account Information #2
Name of Financial Institution:
%________________
Routing Number:
$_________________
Account Number:
☐ Checking | ☐ Savings
Account Information #3
Name of Financial Institution:
%________________
Routing Number:
$_________________
Account Number:
☐ Checking | ☐ Savings
Signature
Authorized Signature (Primary):
Date:
Authorized Signature (Secondary):
Date:
Please attach a voided check or deposit slip and return this form to the Payroll Department.
Pay Check Direct Deposit Authorization Agreement I hereby authorize The Episcopal Diocese of Oklahoma to initiate automatic deposits to my account at the financial institution named below. I also authorize The Episcopal Diocese of Oklahoma to make withdrawals from this account in the event that a credit entry is made in error. Further, I agree not to hold The Episcopal Diocese of Oklahoma responsible for any delay or loss of funds due to incorrect or incomplete information supplied by me or by my financial institution or due to an error on the part of my financial institution in depositing funds to my account. This agreement will remain in effect until The Episcopal Diocese of Oklahoma receives a written notice of cancellation our business office, or until I submit a new direct deposit form to the Accounting Department.
Account Information #1
Name of Financial Institution:
%________________
Routing Number:
$_________________
Account Number:
☐ Checking | ☐ Savings
Account Information #2
Name of Financial Institution:
%________________
Routing Number:
$_________________
Account Number:
☐ Checking | ☐ Savings
Account Information #3
Name of Financial Institution:
%________________
Routing Number:
$_________________
Account Number:
☐ Checking | ☐ Savings
Signature
Authorized Signature (Primary):
Date:
Authorized Signature (Secondary):
Date:
Please attach a voided check or deposit slip and return this form to the Payroll Department.
